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var pn, fn, ln, rp, nextBtn;
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<div id="bannerStrip">
	<div id="logo"><img src="images/title.gif" alt="Automobile Insurance Claim" width="273" height="40" border="0" /></div>
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	<span class="pageUpdateText">Welcome <span class="csr"><script>document.write(get_cookie("user"))</script> </span>! <a href="login.html" class="logout">Log out</a>
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<div class="position"><a href="welcome_csr.html">Home</a> > Create New Claim</div>
<div class="applicationPanel">
<div id="headerT">
	<div id="headerText">Automobile Insurance</div>
</div>
	<div class="leftPanel">
	  <div class="buttonscontainer">
		<div class="buttons1" id="highLightLeftNav"><a href="#">Create New Claim</a></div>
			<div class="buttons1"><a href="view_claims_csr.html" onClick="hide('t01','i01')">View Claims <img id="i01" src="images/ico_sub.gif"></a></div>
			<div id="t01" style="display:none;">
			<div class="buttons" id="c"><a href="#" onClick="javascript:document.getElementById('statusType').value='New'; document.getElementById('selector1').style.display='none'; changeItems();">Draft (4)</a></div>
			<div class="buttons" id="c"><a href="#" onClick="javascript:document.getElementById('statusType').value='Open'; document.getElementById('selector1').style.display='none'; changeItems();">Open (6)</a></div>
			<div class="buttons" id="c"><a href="#" onClick="javascript:document.getElementById('statusType').value='Approved'; document.getElementById('selector1').style.display='none'; changeItems();"> Approved (3) </a> </div>
			<div class="buttons" id="c"><a href="#" onClick="javascript:document.getElementById('statusType').value='Rejected'; document.getElementById('selector1').style.display='none'; changeItems();"> Rejected (4) </a> </div>
			<div class="buttons" id="c"><a href="#" onClick="javascript:document.getElementById('statusType').value='Closed'; document.getElementById('selector1').style.display='none'; changeItems();"> Closed (2) </a> </div>
			<div class="buttons" id="c"><a href="#" onClick="javascript:document.getElementById('statusType').value='All'; document.getElementById('selector1').style.display='block'; changeItems();"> All (19)</a></div>
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	<div class="rightPanel">
	<div class="position"><img src="images/ico_current.gif" /> Basic information  &nbsp;&nbsp;&nbsp;&nbsp; <img src="images/ico_w.gif" /> <span class="grey">Accident details</span> &nbsp;&nbsp;&nbsp;&nbsp;<img src="images/ico_w.gif" /> <span class="grey">Confirmation</span><br />
	<hr size="1" color="#999999">
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		<div class="grayHeaderText"><img src="images/reported.gif"> Basic information<br /></div>
		<div class="grayHeaderText" id="providemore" style="display:none;"><img src="images/ico_error.gif"> Sorry, too many results match, please provide more exact conditions!</div><br />
	  <form name="s">
			<div class="row">
			  <span class="label">Policy Number:</span>
			  <span class="formw">
			  	<select id="pn-dropdown" size="10" style="position:absolute; visibility:hidden; margin-top: 22px; width: 292px; background-color:#DEE9FA; border: 1px #999999 solid; font-size:13px; color:#003366; overflow:auto;z-index:3; filter:alpha(Opacity=80);"></select>
			  	<input name="pn" id="pn" type="text" class="box1" value="" onKeyUp="checkrp()" maxlength="7" autocomplete="false" />&nbsp;<span id="rp" style="font-size:12px; display:none;"><a href="#" title="Retrieve Policy" onClick="MM_openBrWindow('policy1.pdf','Policy','scrollbars=yes,width=650,height=450')">Retrieve policy</a></span>
			  </span>
			</div>
			<div class="row">
			  <span class="label">First Name:</span>
			  <span class="formw">
			  	<select id="fn-dropdown" size="10" style="position:absolute; visibility:hidden; margin-top:22px; width: 292px; background-color:#DEE9FA; border: 1px #999999 solid; font-size:13px; color:#003366; overflow:auto;z-index:3; filter:alpha(Opacity=80);"></select>
				<input name="fn" id="fn" type="text" class="box1" value="" onKeyUp="checkrp()" autocomplete="false" />
			  </span>
			</div>
			<div class="row">
			  <span class="label">Last Name:</span>
			  <span class="formw">
			  	<select id="ln-dropdown" size="10" style="position:absolute; visibility:hidden; margin-top:22px; width: 292px; background-color:#DEE9FA; border: 1px #999999 solid; font-size:13px; color:#003366; overflow:auto;z-index:3; filter:alpha(Opacity=80);"></select>
				<input name="ln" id="ln" type="text" class="box1" value="" onKeyUp="checkrp()" autocomplete="false" />
			  </span>
			</div><br /><br />
			<div class="row">
			  <span class="label"></span>
			  <span class="formw" style="text-align:center;"><input name="nextBtn" type="button" value="Next" class="btn" onClick="location.href='create_claim2.html'" disabled/>&nbsp;&nbsp;<input type="button" name="resetBtn" value="Reset" class="btn" onClick="clearInput();"></span>
		   </div>
	  </form>
	</div>
</div>
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